A Pediatric and Congenital Electrophysiology Society (PACES) expert consensus statement on the indications and management of cardiovascular implantable electronic devices (CIEDs) for pediatric patients ages 21 years or younger was published July 29 in JACC: Clinical Electrophysiology and presented during the Heart Rhythm Society's annual meeting.

The writing committee, led by Co-Chairs Maully J. Shah, MBBS, FACC, and Michael J. Silka, MD, FACC, highlights variations in previously published statements on adult and pediatric CIED guidance and provides a rationale for these discrepancies in the recommendations. Additionally, the document presents strategies to overcome the obstacles many low- and middle-income countries face with access to CIEDS.

Of note, the authors state that "in patients with isolated sinus node dysfunction, there is no minimum heart rate or maximum pause duration where permanent pacing is absolutely recommended," and explain that clinicians must establish a temporal correlation between bradycardia and the symptoms to determine if permanent pacing is indicated. Further, if patients have abnormal cardiovascular physiology or impaired ventricular function, their symptoms could be linked to sinus bradycardia or atrioventricular synchrony loss. Finally, the authors emphasize the importance of patient-centered care and shared decision-making for patients with indications for CIED implantation.

"The recommendations put forth in this guideline are based on data from observational studies in children, clinical trials in adults, and expert opinion. Clinical trials, especially [randomized clinical trials], remain challenging in pediatric populations because of low overall event rates in specific diseases and variations in disease progression from birth to adulthood," the authors explain.

They conclude that moving forward, "Future research should be conducted … for development of pediatric 'appropriate' CIEDs and device algorithms to specifically benefit young patients and improve their long-term outcomes."

The document was endorsed by the ACC, the Heart Rhythm Society, the American Heart Association, the Association for European Paediatric and Congenital Cardiology, the Asia Pacific Heart Rhythm Society, the Indian Heart Rhythm Society, and the Latin American Heart Rhythm Society.

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Sick Sinus Syndrome, Bradycardia, Decision Making, Heart Rate, Arrhythmias, Cardiac, Cardiac Electrophysiology, Cardiovascular System, Ventricular Function, Patient-Centered Care

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